Provider Demographics
NPI:1093794570
Name:KOLEK, CAROL E (LICSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:E
Last Name:KOLEK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-0071
Mailing Address - Country:US
Mailing Address - Phone:508-758-3757
Mailing Address - Fax:508-758-3755
Practice Address - Street 1:19 COUNTY RD
Practice Address - Street 2:
Practice Address - City:MATTAPOISETTE
Practice Address - State:MA
Practice Address - Zip Code:02739
Practice Address - Country:US
Practice Address - Phone:508-758-3754
Practice Address - Fax:508-758-3755
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1020691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
102069OtherTUFTS HEALTH CARE
MA1857533OtherMBHP
MA26653OtherMBC HEALTH NET
6251547OtherUNITED BEHAVORIAL HEALTH
005624OtherVALUE OPTIONS
212096OtherMHN
RI213864OtherBCBS
5856653OtherAETNA BEHAVORIAL HEALTH
007162OtherTRICARE
MA1858114Medicaid
MAP06133OtherBCBS MA
1041586OtherCIGNA BEHAVORIAL HEALTH
MA102069OtherLICSW BD OF SW REGISTER
007162OtherTRICARE